Project Summary Infections are the most common complication of hospital care and one of the top 10 leading causes of death in the United States. Multi-drug resistant gram negative organisms (MDRGNOs) account for a steadily increasing rate of infections in healthcare settings every year; including pneumonia, bloodstream infections, wound or surgical site infections, and meningitis. Of particular concern are those infections caused by Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, and specifically carbapenem-resistant Enterobacteriaceae (CRE). The importance of understanding the burden of these infections is emphasized by the impact they have on treatment regimens; requiring more complex therapy. In addition, these organisms have been found to be associated with increased morbidity and mortality, longer length of stay, and increased costs. However, in persons with spinal cord injury and disorder (SCI/D), literature is limited on antibiotic resistance patterns and their impacts on outcomes. Persons with SCI/D are at high risk for these infections compared to the general patient population due to factors such as frequent hospitalization or contact with the health care system, frequent and chronic use of invasive medical devices such as urinary catheters, and development of pressure ulcers. Furthermore, infections are a frequent cause of morbidity and mortality in persons with SCI/D. The majority of Veterans with SCI/D are chronically injured; but we have little data on the burden, risk factors, and impact of antibiotic resistance in this population. The overall objectives of this study are to describe the prevalence of and risk factors for MDRGNOs causing infections in persons with SCI/D, and assess impact of MDRGNOs on patient hospitalization outcomes and long-term outcomes. We propose to conduct a retrospective analysis using national VA medical data sets to achieve these aims. Additionally, we will conduct multiple matched case-control studies to assess impact of MDRGNO's on patient outcomes. The proposed study also addresses a priority area of the VA Rehabilitation Research & Development program as it recognizes the impact of chronic SCI/D on subsequent complications and consequences such as infections. In addition, this study can assist with future efforts and priorities of the VA MDRO Program Office and VA SCI/D Services Program Office in understanding the burden of MDRGNO's and outcomes and determine if further efforts are needed to curb infections caused by this organism.